Funding application form
Accident prevention
______
Funding application form
Please complete every section of this form, replying as fully as possible to every question. This will help us process your funding application.
1. Contact details
PETZL FOUNDATION - - www.fondation-petzl.org - 1
Funding application form
Accident prevention
______
PETZL FOUNDATION - - www.fondation-petzl.org - 1
Funding application form
Accident prevention
______
Full name of your organization:
Address:
Zip / post code: City:
Country:
Website:
Telephone number:
Email:
First name of the project leader:
Last name of the project leader:
Daytime telephone number:
Email:
2. About your organization:
When was your organization founded? (month / year):
Annual budget of your organization in €:
Number of paid employees:
Number of unpaid volunteers:
Number of additional members:
Is the project leader the president of the organization?
Yes No
Your mission statement: (8 lines maximum)
What kind of work does your organization do? Give examples. (10 lines maximum)
3. Have you applied for Petzl Foundation funding before?
PETZL FOUNDATION - - www.fondation-petzl.org - 1
Funding application form
Accident prevention
______
Yes No
4. About your project:
Project summary: (15 lines maximum)
Describe your project and explain how you would use the Petzl Foundation funding.
Your main objectives: (maximum 4 lines by objective)
Describe 4 short-term (one year) and/or long-term (project life) objectives that you hope to achieve. How do you intend to measure your success?
Objective 1 / Success measurement:
Objective 2 / Success measurement:
Objective 3 / Success measurement:
Objective 4 / Success measurement:
Explain how your project meets the following requirements: (maximum 6 lines per answer)
> Your project aims to prevent risks in mountains, cliffs, or, for the professional sector, prevention of risks related to work at height, tree care, technical rescue or difficult access:
> It concerns mountains or another type of vertical environment:
> Your project is preventive and not curative (for example, pollution clean-up projects will not be selected):
> Your project has a clearly-defined timeline and is results-oriented, with quantifiable objectives:
Project location:
Budget:
Total cost of the project in €:
Funding allocated by your organization in €:
Funding requested from the Petzl Foundation in €:
Other sources of funding:
> Firm future commitments from other partners, include names of partners and amount donated in €:
> Ongoing commitments from other partners, include names of partners and amount donated in€:
Photos of the project:
Please provide at least 3 photos in JPEG format. Size recommended for optimal use: 800x600 (4/3) in Landscape and 450x600 (3/4) portrait, 250 KB to 500 KB with up to 1000 KB (1 MB).
Titles of the photos and photographers’ names:
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Additional information
If you wish, you can send us an additional document to complete your application.
Please email it to: (10 pages maximum)
Additional document: Yes No
PETZL FOUNDATION - - www.fondation-petzl.org - 1